- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $3,801.89 / $5,623.41
| Facility | | $125.89 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $8,709.64
| Facility | | $2,454.71 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $83.18 / $93.33
| Facility | | $74.13 | $83.18 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,818.38 / $4,466.84
| Facility | | $575.44 | $2,818.38 | $4,466.84 |